Let’s Get Back to Basics: Pregnancy and Childbirth Care Provider Options 101

Apr 182013
 

Back to basicsToday, I’d like to get back to basics. For me, Human Rights in Childbirth (HRiC) means that birthing women have the right to choose where, when, and with whom they will have their baby. I realized the other day that I’m writing with the assumption that my audience even knows that midwives exist, let alone the various types of midwives or the laws that apply to midwives. With this in mind, I am going back to the start and define/distinguish the various options that pregnant women have when considering with whom to give birth.

A pregnant woman in Oregon has several options for childbirth that the State recognizes as valid, legal options:

  • A perinatologist handles high-risk pregnancies – they commonly work in clinics that are called something like, “Maternal Fetal Medicine”. They are highly prepared to intervene medically or surgically during pregnancy and birth. Some MFM clinics also care for women who are not high-risk and provide obstetric and nurse midwifery care under the same roof. These doctors only deliver in hospitals, typically in hospitals with appropriate NICU care for babies who need medical intervention to survive.
  • A physician can do all your prenatal care, deliver your baby at the hospital, and follow up with postpartum care.  The most common of these physicians is the obstetrician (the OB in OB/GYN), but some primary care physicians also offer obstetrical care to their patients. Another physician who delivers babies is the DO (Doctor of Osteopathy). Almost all doctors attend births in the hospital.
  • A naturopath midwife (ND) – who is a naturopath with additional training in midwifery. Naturopathic midwives receive a doctoral degree from a four- year accredited naturopathic medical school.  Additionally they complete didactic specialty training, as well as a preceptorship under a licensed naturopathic midwife, in the treatment and management of pregnancy and natural childbirth.
  • A certified nurse midwife (CNM) – has a nursing degree and receives additional training in midwifery. CNMs are supervised by OB/GYNs and provide primarily hospital based services, though there are a handful of CNMs who also do home births. If you are talking about a midwife who practices in a hospital, it’s likely she is a certified nurse midwife, which is legal in every state.
  • A direct-entry midwife (DEM) can actually be applied to several other types of midwives and is kind of a confusing term because it doesn’t offer enough detail. Often all the home birth midwives are lumped into this classification, but it is too simplistic and doesn’t offer any distinction between education and licensure status. A lot of home birth midwives consider themselves to be DEM. Often if you see LDEM as a credential, it means she is a licensed, direct-entry midwife, which is also the same as a CPM. Confused yet? That’s exactly part of the problem!! It gets confusing to talk about “midwives” when there are so many different types of midwives. Direct entry midwifery is not legal in every state. Licensure is not available for direct entry midwives in many states. Direct entry midwifery is a legal option in Oregon; both licensed and unlicensed direct entry midwives are legal options for birthing women in Oregon.
  • A certified professional midwife (CPM) – has completed a midwifery program and/or an apprenticeship to qualify for the NARM exam and has passed the certification exam and met the requirements set forth by NARM for certification. In Oregon, all licensed home-birth midwives must be CPM midwives. The CPM credential does not equal licensure, but is required by most states that do offer a licensure program.
  • A licensed midwife (in Oregon) is also a certified professional midwife, by default, because certification by NARM is a requirement for licensure. Licensure (in Oregon) currently requires a midwife to be certified in basic CPR and neonatal resuscitation, take an LD&D class (Legends, Drugs, and Devices) for certification in order to use a limited number of pharmaceuticals, such as Pitocin and Cytotec (anti-hemorrhagics) and also to administer an IV, catheter, and other procedures that are unique to licensed midwives. Licensure permits a CPM midwife to bill the Oregon Health Plan for midwifery care in certain circumstances. Licensed midwives adhere to a set of laws and rules that are determined through legislative processes and hearings. Licensed midwives are regulated through the Oregon Health Licensing Agency (OHLA). Complaints against licensed midwives are made to the OHLA board, are investigated by OHLA, and are disciplined through OHLA. For more information about licensed midwives in Oregon, you should visit the OHLA Direct Entry Midwifery Board website, where there is a ton of information, including a searchable license database. Not every state has a licensure program, which means home birth midwifery is still illegal with a CPM midwife in many states.
  • An unlicensed midwife is often called a “lay midwife” or a “traditional midwife” and is a legal option for pregnant women (in Oregon). Though midwives with a CPM are eligible for licensure, some choose to remain unlicensed, while other unlicensed midwives may not have completed the requirements or the process for certification and are truly “lay midwives.” Some unlicensed midwives have comparable educational and experiential backgrounds as licensed and certified professional midwives. Lay midwives typically depend on natural methods and herbal remedies to manage complications at birth, as legal access to carry oxygen, pharmaceuticals, and to do certain procedures is only provided with licensure. I think it’s important for consumers (mothers) to understand that hiring an unlicensed also means that consumers (mothers) do not have a regulatory agency who will investigate a report should they choose to file a complaint. In some cases, unlicensed midwives have been investigated and subsequently disciplined through the criminal court system rather than through the licensing board, as the laws and regulations and appropriate disciplinary action of the licensing board would not apply to an unlicensed midwife.
  • Just to be super clear, a doula isn’t a pregnancy or a birth care provider at all. Doulas provide emotional and educational support only – they do not do prenatal care, nor do they deliver (or catch) babies.

So the next time you see Ima Midwife, CPM, LDEM you will know that this is a certified professional midwife who is also a licensed direct entry midwife (a home birth midwife), and you may get to know my friend, Shesa Midwife, DEM, who is an unlicensed direct entry midwife, and if you run into Youra Midwife, CNM, you’ll know she’s most likely a hospital based certified nurse midwife.

What kind of a birth provider did you choose and why?

 

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Another Beautiful Pregnant Belly Henna Tattoo at the Portland Mama Baby Center

Jun 022012
 

pregnant belly henna tattoo at portland mama baby center

This morning at the Portland Mama Baby Center, Ana spent a couple of hours with a lovely Mama doing this henna tattoo. I think it’s gorgeous. I really can’t say enough how much I love pregnant belly henna. What a great baby shower or blessingway gift, too! If you’d like to gift a henna belly tattoo to someone, just let me know and I’ll whip up a special little gift card for you to give to Mama.

If you’d like to schedule some time for your own pregnant belly henna tattoo, please just get in touch with Kate. It’s easy.

By email: kate@portlandmamababycenter.com

By phone: (503) 206-7715

By text: (503) 451-3452

On Facebook  | On Twitter

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Herbs for the Childbearing Year at Portland Mama Baby Center

May 302012
 

herbs for the childbearing year

Herbs for Women in Their Childbearing Years
With Jessica Elliott

  • Herbs every women should have in her life.
  • Fertility & conception.
  • Nourishing herbs during pregnancy.
  • Herbal solutions for common pregnancy complaints.
  • Postpartum herbs for the perineum.
  • Milk supply herbs.
  • Preventing & treating postpartum blues.

CLASS: Herbs for Women in their Childbearing Years
WHEN: August 18 from 10am to 4pm.
WHERE: Portland MamaBaby Center (map)
RECOMMENDED PREREQUISITE: Herbs for Everyone
COST: $75.00. 

To register, simply download our registration form and attach your payment.

Return your completed registration form and payment to Portland MamaBaby Center at 5528 SE Woodstock Blvd. Portland, OR 97206. We also accept Paypal and major credit card. If you wish to use PayPal or a credit card, please fill out the registration form and send it in and then contact Kate directly (kate@PortlandMamaBabyCenter.com) to make your payment.

For specific questions about the class, please email Jessica at Jessica@PortlandMamaBabyCenter.com

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Top 5 “Ask The Birth Doula” Questions

Apr 182012
 

There are some questions that almost every pregnant woman, client or not, asks me when she finds out I’m a labor and birth doula, so I’m going to share them with you. For more general frequently asked questions, check our our FAQ page.

1. What exactly does a birth doula do?

Pregnant Belly Beautiful DoulaWell, that depends on the client and the type of birth she is planning! In general, a doula is there to provide you with prenatal education and counseling, to educate and support you in the choices you make in planning your birth, and then to help you through your labor and delivery by providing emotional, physical, and spiritual support. A doula is not just a ‘lamaze coach’, but I feel like when I say that a doula is kind of like the a good old fashioned labor coach, most people begin to understand what it is that we do. Of course we do more then hold your leg and yell “PUSH” in your face… in fact, your doula shouldn’t probably do that…

At a birth I may be talking a Mama through each contraction. Later I might be out of the room giving a woman and her partner some space and time to enjoy their last moments as a couple. When I return we might try a different position or grab some equipment like a birth stool or a birth ball. I might suggest a hot shower or soaking in the tub. …I might just stand back and take photos as Mama and her partner(s) slow dance through contractions. No labors are the same, and accordingly, no doula experience is the same.

In some cases, your doula may be the ::only:: person on your birth team who is with you from start to finish. Nurses come and nurses go. Doctors go off call and their partners cover them, and even midwives in some practices have a partner who covers births for them under certain circumstances. In a home birth transfer, your doula will be a familiar face that will never leave your side. Most people who had great doula experiences express that their doula becomes a part of their family – that they are bonded by the birth experience. This is definitely the case for me, and each and every one of my clients and their babies hold a very special place in my heart.

2. Why the big differences in doula fees?

It’s hard to say why or how other doula set their fees. I think some doulas set their fees very low because they are trying to gain experience. Of course, location is a big factor. After evaluating the hours each doula invests in prenatal and postpartum visits, the time and energy each doula lovingly puts into emails, texts, and phone calls between visits, before, and after the birth, the actual labor and delivery (which could realistically last as long as a 40 hour work week in just 2 days) along with factoring in the cost of workshops and continuing education necessary to be the best in our field, I set our standard doula package at $950.00. It’s certainly not the highest doula fee in town, but you won’t have to do a lot of searching to find a cheaper doula either. Our doulas, however, do have to make a living as birth professionals because a hobbyist doula who has to works another job cannot be the professional doula that you want at your birth.

Also, it’s important for me to share with you that $50 of each birth that we do benefits the MamaBaby Clinic, providing prenatal care for women who cannot otherwise afford to see our midwife, so by hiring one of our doulas, you are helping other Mamas.

3. Do doulas bill insurance?

Typically, no. Like every other birth doula I know, we do not bill any insurance plans for doula care at this time. We are happy to provide you with all the paperwork that you need and the codes that you’ll need for the forms to submit your own claim to your insurance company and we definitely encourage you to do that. Every once in a while, an insurance company pays and reimburses you, especially if you can get your OB or midwife to write a letter that supports your claim that a doula is medically a necessary part of the birth team and potentially could save them a lot of money. Even if you are denied, the more claims that are submitted to insurance companies, the more it demonstrates an objective need for the insurance company to decide that doula care should be covered. Without customer demand (that’s you) they will never supply the benefit.

4. If you have a doula does that mean you can’t have an epidural?

Generally speaking, people who hire us to be a their doulas are trying to avoid an epidural and the cascade of interventions that often accompanies them. Our clients are typically educated about epidurals and we work in our prenatal visits to educate them even more about the risks vs. benefits of epidurals. epidural placed low back tattooLike most professional doulas, I set a code word with Mamas. Sometimes they just want to vocalize, “I want an epidural so bad…” but they don’t actually want to change their plan, they just need to feel safe to say that. If women are serious about it, we have ‘the talk’. I remind my client that it was her original plan to avoid an epidural and I check in to make sure that her choice isn’t coming from fear that she isn’t strong enough or powerful enough to manage the contractions. Sometimes Mamas are so tired, they just need to be reminded that this is a finite process and I will soon leave them tucked in to rest with their baby, and extra emotional support is all they need to make it through a rough patch.

Sometimes, Mamas really do need or want an epidural, and then I see my duty to see that she feels good about that decision. So no, having a doula does not mean that you can’t have an epidural. In fact, you may end up feeling more empowered about your choice to have an epidural because of your doula. You should never be made to feel like you disappointed your doula if you choose an epidural for yourself! It’s your birth. You don’t have to have your doula’s permission to do ::anything:: you choose to do at your birth. It’s our job to support you. Period.

5. Do doulas have any tricks to start labor?

I’m a firm believer that labor starts when the baby is ready for it to begin. This is one area where I really think that birth is safe and interference is risky. I don’t believe that it’s ethical for obstetricians to be talking about inductions at your 38 and 39 week appointments (I’m just going to go right out and say that, even if I take a hit in client referrals from obstetricians). I think it’s normal for some babies to come at 37 weeks and I think it’s just as normal for some babies to come at 43 weeks.  My only ‘trick’ for starting labor is lots of sex (really go for it, let that oxytocin flow) and swallowing semen. I know some people say you should apply the semen directly to the cervix, but I’m telling you that swallowing semen is the key because the prostaglandins are absorbed systemically through the stomach, which is better than the direct application to the cervix.

Do you have “Ask the Doula” questions you’d like to ask? As soon as I have 5 more, I’ll do another post and share them. Chances are, if you have the questions, so does someone else, so let it rip! You can’t shock me with your questions. I think I’ve heard them all by now :) My email is kate at PortlandMamaBabyCenter.com or you can use the contact form on the website. It also comes to my email.

 To schedule a doula consult, please contact Kate
503.206.7715
kate@portlandmamababycenter.com

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What is a Midwife (Ina May Gaskin)

Apr 062012
 

A Midwife Is:

A trained professional who offers expert care, education, counseling, and support to a woman and her newborn during the childbearing cycle. The midwife works with each woman and her family to identify their unique physical, social and emotional needs. In addition, many midwives provide well-woman gynecological care and family planning services. Midwives know how to watch for and identify potential or actual complications, and they can provide emergency treatment until additional assistance is available.

Midwives offer:

  • Prenatal care that promotes informed decision-making
  • Choice of birth place
  • education and counseling
  • Labor support, birth and postpartum care
  • Support for bonding
  • Examination and evaluation of the newborn
  • Breastfeeding support
  • Counseling in early parenting
  • Well-woman care.

Midwifery Care: Midwives are experts on normal birth; obstetricians are experts on difficult or surgical births. The division of responsibility between two strong and respected professions creates the best conditions for optimal birth care. Midwifery care is cost effective; midwifery fees are typically less than fees for comparable services provided by physicians; midwifery care saves money without sacrificing quality or safety.

Midwives provide personalized care

Women want more than technological care during pregnancy and birth. Midwives encourage participation by family members and provide continuous support during labor and birth.

Midwives trust the birth process and affirm each individual woman’s ability to give birth.

Midwives encourage informed choice

Midwives encourage women and their families to take an active part in their own health care. Pregnancy is an ideal time to educate mothers about nutrition, healthful birth practices breastfeeding and infant care.

Midwifery care offers choice of birth place

Midwives practice in homes and birth centers. Midwives support the right of the parents to choose the birth place that best suits their needs.

Midwifery care makes a difference

Midwives worldwide have an excellent record of safety with numerous studies associating midwifery care with excellent outcomes. In five nations with the lowest infant mortality and lowest rates of technological intervention, midwives attend 70% of all births without a physician in the birth room.

Midwifery in the United States

Midwives are recognized throughout the world as the most appropriate maternity care provider for most women. Midwifery licensure and scope of practice in the United States is regulated by individual state laws. The following categories of professional midwives are recognized in the United States.

Direct-Entry Midwives “Direct-entry” midwives, who are licensed in some states, are not required to become nurses before training to be midwives. The Midwifery Education and Accreditation Council (MEAC) is currently accrediting direct-entry midwifery educational programs and apprenticeships in the United States. Direct-entry midwives’ legal status varies according to state, and they practice most often in birth centers and in homes. Currently in the state of Oregon licensure is optional, some midwives choose to become both certified and licensed and some chose to remain unlicensed.

Certified Professional Midwives (CPMs) may gain their midwifery education through a variety of routes. They must have their midwifery skills and experience evaluated through the North American Registry of Midwives (NARM) certification process and pass the NARM Written Examination and Skills Assessment. The legal status of these nationally credentialed direct-entry midwives varies from state to state. In some of the states where they are also individually licensed, midwives’ services are reimbursable through Medicaid and private insurance carriers.

[Note: The Portland MamaBaby Center's Resident Midwife, Tia Rich, is a Certified Professional Midwife (above)]

Certified Nurse-Midwives Certified Nurse-Midwives (CNMs) are educated in both nursing and midwifery. After attending an educational program accredited by the American College of Nurse-Midwives Certification Council (ACC), they must pass the ACC examination and can be licensed in the individual states in which they practice. CNMs practice most often in hospitals and birth centers.

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Source: “What is a Midwife” pamphlet shared with permission by Ina May Gaskin

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Hiring a Monitrice Doula: How Monitrice, Midwifery, and Doula Care Are Different and Alike

Mar 292012
 

Monitrice Doula Care at Portland MamaBaby CenterWhat is a monitrice?

What does a monitrice do? How is a monitrice different from a midwife or a doula? How can a monitrice help you to avoid unnecessary interventions in birth, even possibly prevent an unplanned cesarean birth? Don’t be embarrassed if you haven’t even heard of the term. I know a lot of midwives and doulas who are unfamiliar with it. Most people kind of know what a midwife is, and more and more people know what a doula is, but very few people know about a monitrice.

First, let’s begin by defining a doula:

A doula is a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period (Doulas of North America, or DONA, 2011).

A doula works within a very limited scope of practice. Certified doulas are allowed to provide emotional and physical support only. Certified doulas are explicitly prohibited from performing clinical tasks such as doing a dipstick UA, taking blood pressure or temperature, fetal heart tone checks, vaginal examinations, or postpartum clinical care while working and representing themselves as doulas. The bottom line: a certified doula who is being hired to be your doula should never provide clinical care in any way.

Now, the definition of a monitrice:

A monitrice is a birth attendant (typically a woman) with training in maternal and fetal assessment and clinical skills who serves the expectant or new mother during the childbearing year. Her skills include observing vital signs on mother, fetal heart tones on baby, vaginal exams for progress of labor, newborn assessment and care (postpartum doula skills), breastfeeding help, and prenatal education. These skills are performed during prenatal and postpartum visits; as well as, during labor at home. The monitrice does not perform these tasks at the hospital, birthing center, or when the midwife has come to your home unless the caregiver consents.

At the Portland MamaBabyCenter, our monitrice team are experienced certified professional midwives (CPM). Our monitrices come to your home and monitor and assess your labor, just as they would monitor your labor within the midwifery model of care, using the midwifery training they have, until you are ready to transfer to the hospital to meet your nurse midwife or obstetrician for the birth of your baby.

One question a lot of people want to know about monitrice care is if the monitrice does cervical exams to check your progress. Yes and no. Our monitrice team will tell you that while they are absolutely trained to assess your dilation and effacement, it is better to avoid vaginal exams in general and they will encourage you to avoid them. That being said, sometimes women just need to know some numbers to feel confident about remaining at home and our monitrices, as a trained certified professional midwives are absolutely qualified to do that if need be, and in a sterile fashion, if the situation warrants it.

At the point where you transfer to the hospital, monitrice care ends and doula care begins. Your monitrice’s expertise as a CPM still benefits you, but you will no longer receive clinical care from her, as that role will naturally be filled by hospital staff and as she moves into a support only doula role.

In the postpartum period, as a CPM, our monitrices are qualified to help you in ways that a doula could not and that is absolutely one advantage of monitrice-doula combined care. As midwives they have more experience working with postpartum herbs and helping Mamas with breastfeeding than the typical doula will.

Finally, how is a midwife different from a monitrice and a doula?:

[A midwife is] a person trained to assist a woman during childbirth. Many midwives also provide antenatal care for pregnant women, birth education for women and their partners, and care for mothers and newborn babies after the birth. A midwife may be a man or a woman. Midwives may attend the birth of babies in the mother’s home, in a birth centre or in a hospital. The World Health Organization recognizes the midwife as the most appropriate caregiver for women with healthy normal pregnancies and births (WHO 1997).

Midwives have gone through years of highly specialized training in the biological and physiological processes pregnancy and childbirth. Midwives are a primary birth attendant, much like obstetricians and family practice physicians.

How can a monitrice help you to avoid unnecessary interventions and possibly even prevent an unplanned cesarean birth?

Laboring at home in your own environment is ideal for some women who are low-risk and not experiencing any complications. Who wants to labor in a hospital bed anyway? It might be the worst place in the world to labor. It’s not conducive to wiggling that baby through your pelvis, that’s for sure!

Chances are that even with all the excitement you feel about going into labor, you aren’t in such a hurry to get to the hospital as much as you don’t want to wait too long to go. A monitrice helps you to labor longer at home by monitoring the labor process, the Mother’s vitals, and the Baby’s heart tones. This one simple act, that is totally within your control, may be the most important thing you can do if you are planning a natural childbirth in a hospital birthing suite. How does laboring at home longer help you to avoid some unnecessary interventions, including epidurals and unplanned cesareans?

Staying Home Longer Allows You Freedom of Movement

I think that everybody agrees on one thing in childbirth: changing positions during labor is crucial to help with pain relief. Women in labor need to move around. Labor is not a static event – it is very dynamic. Laboring at the hospital almost always involves fetal monitoring, which limits mother’s ability to move freely. Being strapped down with fetal monitors, IVs and other devices restricts her mobility. This is one reason why laboring at home longer is a very attractive option for many mothers who want to move about freely.

Moms May Eat and Drink as Desired at Home

You should be allowed to eat or drink what you want when you want to eat it. Just the act of walking to the kitchen to make tea is good for labor. Many hospitals still restrict a mother’s food intake during labor. Some hospital policies do allow for clear fluids, but many hospitals still will not allow mothers to have any solid food while in labor. Staying home in early labor and through some of active labor allows mothers (and their partner) to eat and drink as they desire.

Laboring at Home is More Comfortable

Do you really need bed rails when you are in labor? In a hospital, the most comfortable place for anyone to sit is usually the bed. Sad statement, considering the mattress is uncomfortable, crinkly, and plasticky and the sheets are not soft and comfy. If you are cold, you’ll have to ask someone for a blanket. If you’re hot or you want fresh air, you may or may not able to open the windows at the hospital. These are little things, but it’s the little things that matter the most, don’t they? Especially at a time as special as the birth of your child.

Moms Rest Better While at Home During Labor

Hospitals are no place for resting. Even worse, sometimes you manage to fall asleep and then a nurse (who is just following hospital protocol) wakes a sleeping Mom to check her vitals. Hospitals and even some birthing centers can be busy places at all hours of the night and day. Lots of people means extra noise which can make it hard for mothers to rest. Some Moms also have a difficult time sleeping in a foreign place with people standing by or walking in at any minute. Who can blame them? It is difficult to let your guard down and sleep when you feel vulnerable. Why not take advantage of the quiet and privacy of your own home for as long as possible? Why is resting a priority in labor? Because sometimes exhaustion can ultimately lead to a cesarean after hours of hard labor. You need every ounce of energy you can get going into the biggest event of your life!

Laboring Women Need Privacy and Intimacy

One big difference about laboring at home is the privacy and the space to be uninhibited with your body and mind and to be intimate with your partner while you are in labor. This intimacy can be really important to the labor process. Hospitals can really inhibit an intimate relationship between Mom and her partner. All of a sudden everyone has to cover their shame, women can become self conscious about their sounds and movements, and you see couples who were kissing and holding each other at home standing arms width apart.

Unnecessary Labor Interventions Can be Avoided by Laboring At Home Longer

Women who are birthing in the hospital are on the clock from the minute they walk through the doors. Doctors, nurses, and hospital administrators (and health insurance companies) all manage labor and delivery according to a timeline and a series of protocols that were created primarily to avoid lawsuits. The longer mothers remain at home, the more their labor will progress at the pace it needs to. Labor often has a natural ebb and flow; slowing down at various intervals and then picking back up again. It is much more likely that if mom’s labor slows down while at the hospital, there will be pressure for her to accept interventions such as having her rupturing her membranes or administering Pitocin.

Quite frankly, if your goal is to birth your baby without an epidural or narcotic pain medication, then the longer you stay away from the hospital, the greater your chance for success. It can be very tempting when you are experiencing contractions to accept the offer to have a very kind anesthesiologist take away all your pain. Many women who have labored at home have no need for an epidural because by the time they get to the hospital, they are ready to push their babies out!

Ready To Hire A Monitrice For Your Birth?

Just call us at the Portland MamaBaby Center

(503) 206-7715

or email Kate (Kate@PortlandMamaBabyCenter.com)

to make an appointment for a free 60 minute consultation with our monitrice team.

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Why I Love Pregnant Belly Henna Tattoo Art

Mar 272012
 

henna belly tattoo artI can’t really tell you exactly why it is that I get so excited when Mamas come to the center for a henna belly art tattoo with Ana. But I do!!

I always offer to stay and take pictures for Mamas of the process to email to them, because I think it’s as cool to see the process as the end result and because henna won’t last forever, but digital photos will. I also will admit that I love watching as art is made from henna onto a beautiful belly while chatting with Mamas. It makes for a great day of work, I’ll tell you!!

I think, I’m so cuckoo for henna right now, in part, because I’ve made the decision not to have any more children, myself, and so I know my last pregnancy was my last pregnancy. I look back now with some wisdom that one can only gain with time and experience and say that I wish I had embraced my pregnancy even more and done all the fun things that you only get to do while you’re pregnant, like have your big belly henna tattoo and take pictures of it and share them with everyone you know!

The fact is, pregnancy is a special time that most of us will only experience at most a few times. For most women I know who have had children, it is the single most important part of your life and the single biggest transition you will make in your life – from being a woman to a mother (no matter how many times it happens, it’s just as profound!)

I think the rituals that go along with pregnancy and birth actually make up the most important part of the pregnancy experience – sharing the news with your friends and family, hearing the baby’s heart beating for the first time and recording it on your phone to play for all your friends to hear, too, seeing your baby on an ultrasound scan for the first time and sharing the photos with the world, taking photos of your belly growing, childbirth classes where you meet your new Mommy friends, baby showers and blessing ways with friends, family, and co-workers all bond you with your baby, your family, and in a bigger sense, to the global community of Mothers that you join, and if you ask me, henna and belly casts should be in that list, too!

Go for it, ladies. You deserve it. You can never go back and do it later. Take it from me. My Big girl is turning 18 this year! Even the photo of her first ultrasound is fading already. It’s hitting me hard that you can never go back and recapture those moments, so seize them. Make them happen. Do whatever you have to do to make this pregnancy the best pregnancy it can be for you.

If you’d like to schedule a henna belly tattoo
or buy one as a gift for someone else
just send me an email or call the center (503) 206-7715

The price is $85.00.

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My Own Personal Interview Questions for Birth Doulas

Mar 272012
 

Finding a the right doula should be easy because doulas typically offer a ‘get to know you’ visit and you can interview dozens of doulas in Portland, but where do you begin and what do you ask the doula? It actually ends up being kind of complicated and overwhelming for a lot of women when it comes time to hire a doula.

I know there are a lot of suggestions out there, but here are some questions that I came up with that I want to know about the doulas that I hire to be a part of the staff at the Portland MamaBaby Center. These are the questions that I typically try to ask in an interview.

I thought I’d share them with you so that you can interview your doulas in a similar, professional way. Hiring a doula isn’t just about finding someone nice to rub your shoulders and tell you you’re doing a great job, it’s also about hiring a birth professional to be a part of your birth team and it’s important (in my opinion) to know that your doula has the heart for the emotional demands of the job and the head for the business of being a doula.

These are the questions I use to guide my decisions when I hire a doula and I hope you will find something in this list of questions that gives you an a-ha! moment:

  • What is your own birth experience like?
  • What led you to be a doula?
  • What is the best part of being a doula?
  • What is the worst part of the job?
  • How do you keep a balance between your work and home life? How do you manage to be away from your family from an undetermined amount of time for a birth?
  • Can you/do you actually support your family doing this kind of work? Do you have another job?
  • What kind of formal training have you had? Are you certified? Will you certify? Why or why not?
  • What books have you read? What’s next on your reading list?
  • What are some workshops you’ve attended? What is the next workshop you ::want:: to attend?
  • What do you see is your role as a doula?
  • What do you see as your strengths as a doula? What separates you from all the rest of the doulas working in Portland?
  • How do you help to manage pain during labor? What are some examples of comfort care you find successful?
  • When would you call in your backup doula? Who do you typically use for back up?
  • Under what circumstances would you leave a Mom in labor?
  • How many clients do you take a month?
  • Are there any other blackout dates in your calendar?
  • Do you have any limitations on where you will go or which caregivers you will work with? Do you have biases against hospital birth? Home birth? Midwives? Obstetricians? How do you deal with those biases?
  • How do you avoid conflict and maintain a positive working relationship with hospital/birth center staff even if you think they are not doing something ‘right’?
  • How do you feel about ___fill in the blank with something you feel strongly about___?
  • What do you wish you had known going into your first birth?

Ask her the tough questions. Doulas are supposed to be honest – you need to know that you can count on her to tell you the truth 100% of the time.  I really recommend you don’t hold back.  What do you really want to know from her?

Also, be prepared for the doula to ask you and your partner questions. She is going to want to know what your experience is like with birth, your views, beliefs, and fears.  She will likely ask about your plans for birth, your feelings about medical interventions, and your expectations of her as your doula.  Part of the initial consultation/interview process is for her to screen you as a client and make sure that you and your partner are right for her doula practice. I would like to think we have a doula for every woman within our practice at the Portland MamaBaby Center, but I sometimes refer clients to other doulas who have expertise in an area that will benefit that family, and ethically it’s just the right thing to refer when you’re not the best person for the job.

Probably the most important question that you could ask yourself and your partner is do you really like her? I tell women that I think that finding the right doula-client relationship is kind of like that spark that you feel when you first meet a new boyfriend or a girlfriend. There is a chemistry aspect to the right doula-client relationship. Chances are, you’ll know within the first few minutes of meeting if this is someone you would want at your birth.

I cannot stress enough how important it is for you to feel really comfortable with your doula. The relationship you will form is a really special relationship (at least in my opinion, it should be.) Not only is your doula going to guide you using the knowledge and wisdom she has acquired through supporting women in labor and through birth, but also she is emotionally invested in guiding you and your family through the emotional and spiritual journey that you are on, whatever that means to you.

 

To schedule a free doula consultation at the Portland MamaBaby Center, please email

Kate [Kate@PortlandMamaBabyCenter.com]

or call (503) 206-7715.

 

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Yummy Snacks For Pregnant Women

Apr 302011
 

Healthy, thoughtful eating while pregnant can do so much in making pregnancy more comfortable, enjoyable, and ensuring that Mama stays low risk and able to birth normally.

One thing that stands in the way of this for women, particularly your normal American woman eating the normal American diet, is snacking. Throwing in the difficulties of eating healthy when rushing off to work in the morning or chasing after other kids can make it even harder.

Mamas often report that eating well can help with nausea, headaches, tiredness, and other “normal” pregnancy ailments. Dr. Brewer also felt that a diet both balanced and rich in vegetables and high in protein could prevent toxemia and premature rupture of membranes. Here are some snacks that are filling, contain protein, and are fairly easy to make.

  • Celery with peanut or almond butter or cream cheese
  • Cottage cheese with fruit or tomatoes
  • Boiled egg, plain or chopped on a salad
  • Apple with peanut butter
  • Raw nuts – you can get them in bulk at your local health food store, almonds are my favorite~
  • Add coconut, pumpkin or sunflower seeds and raisins or dried cranberries to your morning oatmeal or granola, or just mix some of your favorites together for an easy trail mix.
  • Cheese stick
  • Plain yogurt (Nancy’s yogurt is a good one) with some honey or fruit or some raw seeds. I like to layer fruit, berries, yogurt, and honey.
  • Buy or make your own granola with some added seeds
  • Fresh vegetables chopped with hummus to dip. You can make your own hummus with garbanzo beans, buy it dehydrated and just add water and olive oil, or buy it pre-made.
  • Fresh greens or sprouts with olive oil or your favorite dressing and some raw nuts and seeds on top or your favorite cheese
  • Whole grain crackers with cheese
  • Green smoothies – try some kale leaves with a few bananas and molasses to sweeten, enough ice to make it a smoothie and water, juice, or yogurt or milk to make it creamy. It is easy to add other whole food supplements to this too!
  • Air popped popcorn with butter or olive oil and nutritional yeast sprinkled on it

Here in Portland we have some really nutritious snack options! One of my favorite best kept secrets is Bob’s Red Mill in Milwaukie. You can eat something yummy in their cafe or take something with you for home – healthy and nutritious food like steel cut oats and granola galore! Across the street is Dave’s Killer Bread, where you can buy bread with whole grains and seeds and yummy things for you and your baby.

Happy Healthy Snacking!

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Are You A Size-Friendly (Plus-Size Pregnancy) Provider?

Mar 172011
 

Pregnancy can be especially difficult for plus-sized women.

I’m going to go ahead and state that as a fact, since I have experienced two pregnancies, labors, and deliveries as a plus-sized woman.

Emotionally, pregnant women of size may face unfamiliar judgemental looks and comments, however well-intentioned they may be.  Our bodies don’t look the same as the women in all the cute little baby bump pictures.  Maternity clothes don’t fit us right.  Everything that sucks about being a plus-sized woman is amplified in a plus-sized pregnancy. The last thing women with weight issues need is to feel badly about their body with their doula, midwife, or doctor.

Finding a size-friendly childbirth provider can be a challenge.  Women who are obese are discouraged from getting pregnant to begin with.  Then, we are told that our babies will be born big due to gestational diabetes and we probably can’t handle the physical demands of labor.  Homebirth midwives shun us as high risk.  Let’s face it, to some degree, fat women (pregnant or not) are just marginalized in mainstream society.

So, what do you do in our practice to ensure that your clients all feel safe with you?  Are you a size-friendly doula, midwife, or doctor?

Here are some considerations for your practice:

  • Are your birth balls burst resistant to 1,000 lbs.? They should be. And make sure your client knows it, too – because honestly, I would be worried that it would ‘pop’ on me if I weren’t told that it was specially purchased to support my weight.
  • How much weight can your birth stool hold? Consider investing in one that will support women who are overweight.
  • Think about your practice down to the rice packs you have – are they big enough for a plus-size Mama? I have a few that are larger for women with larger spaces to cover.
  • Do you include images of mothers who are overweight on your website and in your literature? (How about some stretch marks here and there?)
  • Do you have scales that can accommodate women weighing over 250 lbs? (One Mama I know told me that her doctor told her, “We used to weigh people like you on meat scales.” WTW?! Are you kidding me??!! I would immediately find a new doctor. She did.)
  • Do you have (and use!) a large blood pressure cuff with all women of size to get an accurate reading?
  • Does your office have seating that can accommodate a larger woman carrying extra weight for pregnancy without giving her concern that she’s going to break the chair? (These things really do cross our minds!)
  • How do you discuss health risks associated with obesity in pregnancy without provoking self-sabotaging guilt? (This one is tricky, because sometimes you have to say the things that clients don’t want to hear, but there is definitely a way of addressing these issues without causing more guilt and more negative feelings)
  • Have you given consideration to special breastfeeding booby traps she might face? (Positioning very large breasts with baby is difficult at first)
  • Have you addressed the challenges of babywearing with your plus-sized Mama? (traditional baby carriers will probably not fit, teach her to use a rebozo!)

Perhaps the most important question of all:

Do you genuinely feel comfortable with women of size?
Be honest with yourself about this one.  You are expected to hold this woman up, to touch her body, to look her in the eyes and tell her she can do it!  If you don’t feel truly empathetic and nonjudgemental, then do her a favor and recommend a colleague who can. We’ll be happy to take your referrals.

Are you or someone you know looking for a size-friendly doula or midwife in Portland? I want to assure you that you are welcome in our practice. We have thought of all of these things, and more. We are also happy when plus sized mamas want to have us do their belly casting or choose to celebrate their big round belly by doing a special pregnancy henna belly tattoo.

We love helping  plus-sized Mamas feel good about their pregnant bodies and empowered to birth their babies.

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